Personal impact of schizophrenia needs addressing

Current psychiatric services in Europe appear to be largely ineffective in managing the impact of schizophrenia on a patient's work, home, and family life, say researchers who suggest that services need to address more than just the symptoms of the disease.

The "personal" impact of schizophrenia and the way it disrupts the everyday lives of people with the illness and their families has been explored much less than the social impact of the condition, observe Graham Thornicroft (Kings College London, UK) and colleagues.

To investigate, the researchers compared groups of schizophrenic patients receiving treatment from five European cities - Amsterdam, London, Copenhagen, Santander, and Verona - as part of the European Psychiatric Services: Inputs Linked to Outcome Domains and Needs (EPSILON) study.

Information was gathered to assess unmet needs, quality of life, symptoms, disability, and satisfaction with services.

Of the 404 patients involved, 79% were unemployed, with those from the Northern European countries receiving welfare benefits, while those from the Southern European countries were largely supplemented by family members. In all, 65% of patients were single, with many patients living alone or with their families.

The predictors of a low quality of life were essentially clinical, including symptoms of anxiety, depression, and the number of previous psychiatric admissions. However, having no reliable friends or daily contact with family, being unemployed, and having few leisure activities also had an effect.

The researchers found that low levels of patient satisfaction with services were associated with being retired or unemployed, having more hospital admissions, more psychopathology, and more unmet needs. The most frequently reported unmet needs for the patient sample as a whole were daytime activities, company, psychotic symptoms, psychological distress, information, and intimate relationships.

"This implies that research, clinical practice, and disability policy developments need to address a wider range of consequences of the disorder than symptoms alone, and such a broader view could encompass family-based interventions," Thornicroft and colleagues conclude in the journal Schizophrenia Research.